Can a disability insurance company rely upon a nurse to review my disability claim?

Hartford and many other disability insurance companies employ nurses to do preliminary reviews of medical records. The cost of a nurse on staff versus a physician is much less for a disability insurance company. Also, the claim rep assigned to your disability insurance claim is not a medical profession and they have no idea how to interpret your medical records.

It is OK for an insurance company to use a nurse, but if the nurse makes a determination that differs from your orthopedic, then it is a big problem for the insurance company.

Unfortunately, these nurses think they know more than some doctors and we have seen Hartford Disability Claims denied based upon only a nurse review.

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There are 3 comments

  • Vickie,

    Review your applicable policies. Most will have worker’s compensation as an “Other Income Benefit” subject to offset. If your policies indicates same then the entity that issued disability benefits (be it employer or the insurance company) would have right to collect repayment of an overpayment.

    Stephen JessupSep 10, 2013  #3

  • FYI: Sedgwick CMS and Hartford merged a few years ago. My employer is self insured the employer accepted my injury but sent me over to their STD instead of paying WC no TD or PD was paid. The employer is now attempting to recover STD through subrogation. However the STD was not paid by the TPA it was paid by the employer. If the employer recoups STD from any WC settlement wouldn’t that constitute me paying for my own WC since the employer is self insured and paid out the STD payments.

    Vickie WilliamsSep 9, 2013  #2

  • Yes, this is what I am going through. My STD case was closed even though I continue sending doctor forms saying I had acute illness; still for two more months now they say nurse is reviewing my case. They’re now saying the doctor took me off for one more month and did not have a good explanation saying due to surgery recovery was not good enough words. I was still having severe pains and between the surgeon, my primary physician, and a gasterologist I was taking antibiotics and pain medicine which kept me drowsy, dizzy and stressed out. No one could really know the pain I was feeling. How can a nurse ever question a surgeon taking a patient off work, I don’t understand! I only received one or two week paycheque from Cigna short term disability and was off work a total of 11 weeks. Now I have been back to work and still can’t get paid.

    ConfusedSep 4, 2013  #1

FAQ

Do you work in my state?

Yes. We are a national disability insurance law firm that is available to represent you regardless of where you live in the United States. We have partner lawyers in every state and we have filed lawsuits in most federal courts nationwide. Our disability lawyers represent disability claimants at all stages of a claim for disability insurance benefits. There is nothing that our lawyers have not seen in the disability insurance world.

What are your fees?

Since we represent disability insurance claimants at different stages of a disability insurance claim we offer a variety of different fee options. We understand that claimants living on disability insurance benefits have a limited source of income; therefore we always try to work with the claimant to make our attorney fees as affordable as possible.

The three available fee options are a contingency fee agreement (no attorney fee or cost unless we make a recovery), hourly fee or fixed flat rate.

In every case we provide each client with a written fee agreement detailing the terms and conditions. We always offer a free initial phone consultation and we appreciate the opportunity to work with you in obtaining payment of your disability insurance benefits.

Do I have to come to your office to work with your law firm?

No. For purposes of efficiency and to reduce expenses for our clients we have found that 99% of our clients prefer to communicate via telephone, e-mail, fax, GoToMeeting.com sessions, or Skype. If you prefer an initial in-person meeting please let us know. A disability company will never require you to come to their office and similarly we are set up so that we handle your entire claim without the need for you to come to our office.

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When you call us during normal business hours you will immediately speak with a disability attorney. We can be reached at 800-682-8331 or by email. Lawyer and staff must return all client calls same day. Client emails are usually replied to within the same business day and seem to be the preferred and most efficient method of communication for most clients.

Reviews

Bruce R. (Arizona)

Steve Dell has done an exceptional job with my disability application process. The firm is extremely well managed. They have acquired an incredible amount of experience over many years. I recommend them for disability insurance claims without reservation. 

Don (Florida)

I called this firm a few months ago completely disparaged due to a company cutting off disability benefits at a time that nearly caused me to lose everything.

Attorney Alex Palmera and Danielle worked hard to reach an amicable settlement and my case was settled a few months later. This is a good firm and the specific expertise in disability claims saved me countless hours of hassle at a time when an already fragile state existed.

Thank you Mr. Palamara and Danielle.

Sandra B. (Arkansas)

I have nothing but good things to say about how my buyout was handled with my disability claim. The level of professionalism was amazing. All of my questions and concerns were answered either by Danielle L. or Alex P. in such a timely manner and with such care I would recommend them in a heartbeat to anyone needing to approach their provider with buyout options.

They did a fantastic job communicating between the provider and me, always keeping my best interest at heart and always answering my many many questions. They really did take most of the stress out of this whole situation. I would give them a 10 out of 10 for every step of this crazy journey. Thank you so much for helping me through this.

Brenda R. (New York)

I needed assistance with an appeal for a LTD claim that was initially denied. Stephen understood what needed to happen to win the appeal and he did win the appeal for me.

Michael C. (Virginia)

Greg Dell and his assistant Anneli have been extremely responsive and helpful, not only our initial consultations, but in follow-ups 1 and 2 years later with the insurance company to ensure that they comply with their agreements (which they did), as well as a separate and only slightly-related inquiry about our health insurance. I always hear back from them very quickly, which is rare and greatly appreciated.

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